Human immunodeficiency virus/acquired immunodeficiency syndrome prevalence, incidence, and mortality in China, 1990 to 2017: a secondary analysis of the Global Burden of Disease Study 2017 data

Abstract

Background: Despite almost two decades of well-funded and comprehensive response efforts by the Chinese Government, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a major problem in China. Yet, few studies have recently examined long-term trends in HIV/AIDS prevalence, incidence, and mortality at the national level. This study aimed to determine the prevalence, incidence, and mortality trends for HIV/AIDS over the past 28 years in China. Methods: We conducted a descriptive, epidemiological, secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 data. To evaluate trends in prevalence, incidence, and mortality over the study period from 1990 to 2017, we calculated values for annual percentage change (APC) and corresponding 95% confidence intervals (CIs) using joinpoint regression analysis. Results: A significant increase in HIV/AIDS prevalence was observed for 1990 to 2009 (APC: 10.7; 95% CI: 10.4, 11.0; P < 0.001), and then remained stable for 2009 to 2017 (APC: 0.7; 95% CI: −0.3, 1.7; P = 0.1). A significant increase in HIV incidence was also observed for 1990 to 2005 (APC: 13.0; 95% CI: 12.6, 13.4; P < 0.001), and then a significant decrease was detected for 2005 to 2017 (APC: −6.5; 95% CI: −7.0, −6.1; P < 0.001). A significant increase in AIDS-related mortality rate was detected for 1990 to 2004 (APC: 10.3; 95% CI: 9.3, 11.3; P < 0.001), followed by a period of stability for 2004 to 2013 (APC: 1.3; 95% CI: −0.7, 3.3; P = 0.2), and then another significant increase for 2013 to 2017 (APC: 15.3; 95% CI: 8.7, 22.2; P < 0.001). Conclusions: Although prevalence has stabilized and incidence has declined, AIDS-related mortality has risen sharply in recent years. These findings suggest more must be done to bring people into treatment earlier, retain them in treatment more effectively, actively seek to reenter them in treatment if they dropout, and improve the quality of treatment and care regimens.

Research Progress in the Epidemiology of HIV/AIDS in China

“…To further address the challenges in maintenance of a sustainable national ART program and a continuum of HIV care, including implementation of the test-and-immediately-treat policy and provision of care for individualized health needs of the patients (46)(47), China is examining various service models for treatment and care. For example, the previous CDC-led AIDS treatment program and mode of management had been transferred to the hospital-based model years ago, which had proved to be effective and successful (48). Most recently, as the body of PLWH continuously increases, a community-based model for patient management is being examined to ameliorate work overload suffered in the hospital-based model.…”

“…With a secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 data, Liu et al observed that the HIV prevalence in China increased from 1990 to 2009 with an annual percent change (APC) of 10.7, and then remained stable from 2009 to 2017 (APC: 0.7) ( 49 ). A significant increase in HIV incidence was also observed for 1990 to 2005 (APC: 13.0) and then a significant decrease was detected for 2005 to 2017 (APC: –6.5).…”

“…A significant increase in HIV incidence was also observed for 1990 to 2005 (APC: 13.0) and then a significant decrease was detected for 2005 to 2017 (APC: –6.5). However, the AIDS-related mortality has increased sharply for 1990 to 2004 (APC: 10.3) and for 2013 to 2017 (APC: 15.3), although it stabilized for 2004 to 2013 (APC: 1.3) ( 49 ).…”

Prevention and control of HIV/AIDS in China: lessons from the past three decades

“…[ 13 ] Successful efforts to curb injection drug use and illegal blood collection have led to the emergence of sexual transmission, both heterosexual and homosexual, as the major route for HIV infection in recent years. [ 9 ] In 2019, there were 71,204 newly infected HIV/AIDS cases in China, among whom, nearly zero HIV infection through blood transfusion were reported; the mother-to-child transmission rate decreased to minimal levels, and >95% we are through sexual behaviors. [ 14 , 15 ] Between 2006 and 2020, the proportion of cases resulting from homosexual transmission increased from 2.5% to 33.4%, and about eight out of every 100 men who have sex with men (MSM) lived with HIV/AIDS; as well as the proportion resulting from heterosexual transmission increased from 30.6% to >66.5% [Figure 1 ].…”

“…The Joint United Nations Programme on HIV/AIDS (UNAIDS) previously estimated that the number of HIV-infected individuals in China could reach 10 million by 2010; [ 7 ] however, China has been able to limit the epidemic to <0.1% of HIV prevalence as of the end of 2017. [ 8 , 9 ] And by October 2020, there were 1.045 million people actually reported living with HIV/AIDS across China. [ 10 ] The political commitment, social engagement, and international support that are jointly responsible for this remarkable achievement have rarely been evaluated or reviewed.…”